INDIVIDUAL PROFILE FORM

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The fields marked with " * " are required!
Name: *

Adress: *

City: *
State: *
Zip: *
Phone: *
E-Mail: *
Current Position / How Long:
  

State Licenses
Held:
(please check all that apply)
Alabama
Nebraska
Alaska
Nevada
Arizona
New Hampshire
Arkansas
New Jersey
California
New Mexico
Colorado
New York
Connecticut
North Carolina
Delaware
North Dakota
District of Columbia
Ohio
Florida
Oklahoma
Georgia
Oregon
Hawaii
Pennsylvania
Idaho
Rhode Island
Illinois
South Carolina
Indiana
South Dakota
Iowa
Tennessee
Kansas
Texas
Kentucky
Utah
Louisiana
Vermont
Maine
Virginia
Maryland
Washington
Massachusetts
West Virginia
Michigan
Wisconsin
Minnesota
Wyoming
Mississippi
Missouri
Montana
  
Positions Of Interest:
(please check all that apply)
Hospital Staff Pharmacist
Hospital Director of Pharmacy
Hospital Pharmacy Technician
Hospital Pharmacy Account Manager
Hospital Interim Pharmacy Manager
Hospital Clinical Pharmacy Manager
Clinical Manager - PharmaCare Services System
 
Other:
  
Desired Schedule:
(please check all that apply)
Full-Time
Part-Time
7 On 7 Off
Interim Staffing
Weekends
PRN
  
Willing To Travel?
Yes
 
Regionally?
Nationally?
No
 
Region Of The Country Preferences:
  
Willing to Relocate?
Yes
 
No
Region Of The Country Preferences:
  
Education Certification:
(please check all that apply)
CPhT
RPh
PharmD
Nuclear Pharmacy
IV Certified
  
Years Experience:
Hospital Pharmacy:
  
Retail Pharmacy:
  
Reason For Inquiry:
(please check all that apply)
General Inquiry
Interested in Moving from Retail to Hospital
Assistance With Job Search-Permanent Placement
Interested in Career Paths Offered By Hospital Pharmacy Management Companies
 
How did you hear about PharmaCare Services?

Direct Mail
Print Advertising
Website / E-Commerce
Referral From Hospital Doing Business w/ PharmaCare Services
Other: